School-Based Quality Initiative Improves Childhood Asthma Outcomes
-April 29. 2006 - A quality improvement initiative at four school-based
health centers in Cincinnati has resulted in significant improvements
in outcomes for children with asthma.
results of the project provide support for the concept of school-based
health centers in urban areas and for community partnerships to
improve child health, according to researchers from Cincinnati Children's
Hospital Medical Center involved in the initiative. They presented
their study of the project at 3:15 pm Pacific time Saturday, April
29, at the Pediatric Academic Societies Annual Meeting in San Francisco.
outcomes through evidence-based care shows that school-based health
centers can improve child health," says Mona Mansour, MD, a
physician at Cincinnati Children's and medical director of the school-based
health centers. Dr. Mansour co-authored the study with Barbara Rose,
MPH, who was project manager of the quality improvement initiative.
and Dr. Mansour followed 212 children with asthma who are enrolled
in four school-based health centers in Cincinnati that are operated
by Neighborhood Health Care, Inc., a federally qualified health
center organization. The centers provide comprehensive primary,
mental and dental health services to children in grades K-8. Cincinnati
Childrens provides physicians and nurse practitioners for
these centers and collaborates with the Cincinnati Health Department,
which provides school nurses; the Cincinnati Public Schools; and
parents of children with asthma.
individuals and organizations met and engaged in "visioning
exercises" to determine what "perfect asthma care"
would look like to them. They developed promises and measures to
know whether goals were being met. Perfect care became a composite
measure of asthma severity classification, a written care plan and
appropriate controller medications. Outcomes measures also included
minimal restriction in activity and the number of asthma-related
emergency department visits.
October of 2004 and October of 2005, interventions instituted included
a web-based portal that providers can use to support clinical decisions
and that families ultimately will be able to access to let them
know how their children are doing with their asthma and to get information
about asthma resources. Interventions also included a standardized
process for identifying children with asthma, standardized forms
for data collection during student visits to the school health centers,
and improved delineation of staff roles and responsibilities for
October of 2005, the identification of children with asthma had
risen from 6.2 percent to 15.8 percent. The prevalence of asthma
in urban, African-American communities in Cincinnati is 20.9 percent.
In addition, all measures had improved:
percentage of children receiving perfect care had risen from 24
to 84 percent.
Classification by severity had risen from 17 to 90 percent.
Controllers prescribed had risen from 18 to 86 percent.
A written care plan had risen from 9 to 87 percent.
Children reporting never or rarely having activity restriction rose
from 20 to 46 percent.
Asthma-related emergency room visits decreased 22 percent between
the year prior to the project and the end of the first year of the
The project was part of Pursuing Perfection a national initiative
funded by the Robert Wood Johnson Foundation that was a response
to two reports from the Institute of Medicine. Those reports questioned
the safety, quality, efficiency, effectiveness and fairness of the
nation's health care system and suggested that the system is failing
America because it is poorly designed and must be fundamentally
changed. Pursuing Perfection was intended to be a catalyst for rapid,
transformational change. Cincinnati Children's was selected, along
with six other health care organizations to be a model for the pursuit
of perfect care and was the only pediatric facility among the organizations
participating in the initiative.
most exciting aspect of this project has been in guiding our community
partners in learning about principles of process improvement and
seeing them open participate and cooperate to improve asthma care
to children at school," says Rose. "They get a lot of
credit for their commitment and teamwork over the last two years."
Children's is now planning how best to spread what's been learned
to other school environments.
Children's is a 475-bed institution devoted to bringing the world
the joy of healthier kids. Cincinnati Children's is dedicated to
transforming the way health care is delivered by providing care
that is timely, efficient, effective, family-centered, equitable
and safe. It ranks third nationally among all pediatric centers
in research grants from the National Institutes of Health. The Cincinnati
Children's vision is to be the leader in improving child health.
For more information, visit www.cchmc.org